A phase 1 trial dose-escalation study of tipifarnib on a week-on, week-off schedule in relapsed, refractory or high-risk myeloid leukemia.

Inhibition of farnesyltransferase (FT) activity has been associated with in vitro and in vivo anti-leukemia activity. We report the results of a phase 1 dose-escalation study of tipifarnib, an oral FT inhibitor, in patients with relapsed, refractory or newly diagnosed (if over age 70) acute myelogenous leukemia (AML), on a week-on, week-off schedule. Forty-four patients were enrolled, two patients were newly diagnosed, and the rest were relapsed or refractory to previous treatment, with a median age of 61 (range 33-79). The maximum tolerated dose was determined to be 1200 mg given orally twice daily (b.i.d.) on this schedule. Cycle 1 dose-limiting toxicities were hepatic and renal. There were three complete remissions seen, two at the 1200 mg b.i.d. dose and one at the 1000 mg b.i.d. dose, with minor responses seen at the 1400 mg b.i.d. dose level. Pharmacokinetic studies performed at doses of 1400 mg b.i.d. showed linear behavior with minimal accumulation between days 1-5. Tipifarnib administered on a week-on, week-off schedule shows activity at higher doses, and represents an option for future clinical trials in AML.

The ErbB/HER family of receptor tyrosine kinases: A potential target for chemoprevention of epithelial neoplasms.

Cancer chemoprevention trials can be directed at targeting established molecular mechanisms which contribute to neoplasia. One potential target is the ErbB/HER family of growth factor receptors with intrinsic tyrosine kinase activity. This group of four receptors mediates the action of multiple stromal ligands of the EGF/neuregulin family on the adjacent epithelium. Aberrant autocrine loops and overexpression of certain receptors, especially ErbB-2 (also called HER2 or Neu), play a role in fixation and propagation of oncogenic mutations. Here we concentrate on ErbB-2 and epithelial cancer and discuss current and future therapeutic strategies that may limit cancer, particularly in patients who are at high risk after removal of the primary tumor. Because ErbB-2 acts as a shared co-receptor, and its heterodimers are relatively potent receptor combinations, it offers selectivity that spares other routes of signal transduction. Immunotherapy, as well as gene therapy and tyrosine kinase inhibitors specific to ErbB-2 may join the ranks of effective chemopreventive agents.

Biochemical and clinical implications of the ErbB/HER signaling network of growth factor receptors.

Carcinoma, cancer of epithelial cells, is a major cause of morbidity and mortality in Western societies. Clonal fixation and propagation of oncogenic genetic changes, sporadically accumulating in epithelial cells, depend on growth factors and their surface receptors. One of the large families of receptors is that of the ErbB tyrosine kinases, which bind multiple neuregulins and other epidermal growth factor-like molecules. Certain ErbB members and their ligands are involved in human cancers of various origins. However, most of the clinical data relate to ErbB-2, a protein whose overexpression in subsets of carcinomas can predict poor prognosis. Although no ligand has so far been assigned to ErbB-2, recent biochemical evidence implies that this oncoprotein operates as a shared receptor subunit of other ErbBs. Several biochemical attributes enable ErbB-2 to act as an epithelial cell amplifier of stroma-derived growth factor signals: It delays ligand dissociation, enhances coupling to the mitogen-activated protein kinase pathway, and impedes the rate of receptor downregulation. The realization that ErbB-2 is a master regulator of a signaling network that drives epithelial cell proliferation identifies this protein as a target for cancer therapy. Indeed, various ErbB-2-directed therapeutic approaches, including immunological and genetic therapies, demonstrate promising clinical potential.